Please use your full legal name. (No nicknames)
LEARNER REQUEST FOR SUPPORT NEEDS
DATA EXCHANGE PERMISSION
Applicant hereby provides permission for his/her data to be exchanged with other education and workforce agencies for the purpose of verifying outcomes, performance, and credentials related to postsecondary education/training and employment or other services that are provided by Adult Education.
If I am a recipient of SNAP (formerly known as the Food Stamp program), I am aware that participation in the A-RESET program is voluntary and will not affect my SNAP benefits, but full participation may increase my chances of finding employment of getting a better job.
Please skip the section below on Primary and Secondary Designation.
It will be completed by Adult Education Staff when your enrollment form is processed.